It's a question that women everywhere have pondered at least once or twice in their lifetime: is the pill making me crazy?
Amid great speculation and a pool anecdotal evidence, a team of Swedish researchers has shown one of the most common combined oral contraceptive pills can have a negative impact on a woman's quality of life, but does not increase depressive symptoms.
The scientific base is very limited in regards to the contraceptive pill's effect on the quality of life and depression and there is a great need for randomised studies.
As the most popular form of birth control in Australia, the use of the contraceptive pill is not free from controversy. Whether it has side effects related to well being and mental health is one area with little scientific base.
"Despite the fact that an estimated 100 million women around the world use contraceptive pills, we know surprisingly little today about the pill's effect on women's health," Professor Angelica Linden Hirschberg from the Department of Women's and Children's Health at the Karolinska Insitute said.
"The scientific base is very limited in regards to the contraceptive pill's effect on the quality of life and depression and there is a great need for randomised studies."
What was tested?
The study was double-blinded and gave 340 women aged between 18 and 35 years old either a contraceptive pill or a placebo for three months.
A common form of combined oral contraceptive pill containing ethinylestradiol and levorngestrel -- least associated with a risk of thrombosis (or blood clots) -- was used.
At the start of the study, the women had their general health, including weight, height and blood pressure tested. None of the women were using hormonal birth control at commencement, though some had used it in the past.
Participants were also instructed to fill out the Beck Depression Inventory (BDI) and the Psychology General Well-Being Index (PGWBI). Six separate dimensions of the PGWBI, including positive well-being, self-control and vitality, were evaluated at the end of the trial.
The women in the birth control group showed a small but "statistically significant" drop in general well-being in contrast to those on the placebo.
These findings were not replicated when it came to depressed mood or depressive symptoms.
This possible degradation in quality of life should be paid attention to and taken into account in conjunction with prescribing of contraceptive pills and when choosing a method of contraception.
As to why this occurred, researchers pointed to the effect of progestin, one of two sex hormones that make up synthetic versions of the pill.
"We do not know the mechanism, but we think it could be a direct effect of the progrestin component on the brain," Hirschberg told Buzzfeed.
Combined oral contraceptive pills have both estrogen and progestin, while others only use progestin and yield different results.
The researchers believe the results of the study should be of clinical importance.
"This might in some cases by a contributing cause of low compliance and irregular use of contraceptive pills," researcher Niklas Zethraeus said.
"This possible degradation in quality of life should be paid attention to and taken into account in conjunction with prescribing of contraceptive pills and when choosing a method of contraception."
As with any developments in the contraception space, the results need to be untangled, as Family Planning NSW medical director Deborah Batesman told Huffpost Australia.
If you are experiencing, mood swings on the pill, then it is so important to see your doctor, because there may be an option that suits you better.
"For every study showing a link, there seems to be another showing the opposite," Batesman said.
"This is an important question. We do know that the pill, as all forms of hormonal contraception can have an effect on mood. But there is no causal association as of yet with depression."
The researchers have recognised these limitations.
The study was conducted using one form of combined contraceptive pill, emphasising its findings cannot be generalised to others with varying risk profiles and side-effects.
The short time frame of the study also yields further screening, to understand long term effects.
And it must come back to the individual.
"If you are experiencing mood swings on the pill, then it is so important to see your doctor, because there may be an option that suits you better," Bateman said.
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